Restorative & Materials · patient case question
When is stepwise caries excavation indicated?
Patient case: Caries management, sedation, tumours and ergonomics
Scenario: Five items.
Show answer and explanation
Correct answer: A. A deep lesion in a vital, asymptomatic tooth where complete excavation would likely expose the pulp
- A. Correct. Stepwise excavation is a two-visit technique for exactly this situation: infected dentine is removed, affected dentine is left, the cavity is sealed with calcium hydroxide, and the tooth is reopened after several months once reparative dentine has formed.
- B. A lesion simply reaching the dentino-enamel junction is routine and is managed by conventional excavation in a single visit.
- C. Irreversible pulpitis means the pulp cannot recover. The tooth needs root canal treatment or extraction, not a technique aimed at preserving vitality.
- D. A necrotic pulp is beyond preservation; leaving carious dentine over dead tissue accomplishes nothing.
Note: Selective (one-step) removal to soft dentine is increasingly favoured over the two-visit stepwise approach, with comparable or better pulp survival.
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